Sugar Alcohols

Sizing Up Sugar Alcohols

 Heather Mackie, MS, RD, LD

As a bariatric surgery patient, you most likely have consumed low-calorie and/or sugar-free foods and/or beverages to aid in your weight loss success.  If so, you have probably consumed sugar alcohols.  Sugar alcohols are not sugar.  They are also not alcohol.  This article will review common sugar alcohols and why they are often used, as well as help you to determine if you should consume them or not.


Common Sugar Alcohols    Sugar alcohols have been used in food for quite some time.  Sugar alcohols are one type of reduced-calorie sweetener.  Typically these foods are found in products that are labeled “sugar-free” or “no sugar added.” Some common sugar alcohols you might see in the food industry include: sorbitol, xylitol, maltitol, malitol, lactitol, mannitol, erythritol, isomalt, and polyglycitol (also called hydrogenated starch hydrolysates).  Typically, they are found on the Nutrition Facts panel as “sugar alcohols” under the carbohydrate section.  You will find sugar alcohols in ice cream, cookies, baked goods, jams/jellies, frostings, canned fruit, beverages, pudding, candy, chewing gum, yogurt, protein bars, etc.  You may also find sugar alcohols in bariatric supplements.  Another place sugar alcohols may be seen is in toothpastes, mouthwashes, cough syrup, and throat lozenges. 


Defining Sugar Alcohols     
Sugar alcohols are a group of low-digestible, low-calorie, carbohydrate-based sweeteners.  They are developed by hydrogenating (i.e., adding a hydrogen atom) a sugar or a syrup (i.e., adding a hydrogen atom to lactose makes the sugar alcohol, lactitol).  These sweeteners taste like sugar, but have some advantages, which we will discuss below.  Sugar alcohols provide fewer calories than sugar and have less of an effect on blood glucose (i.e., blood sugar) than other carbohydrates.

Sugar alcohols are used in many foods and beverages because as their ability to deliver the taste and texture of sugar and/or sugar syrups with only half the calories.  


Safety of Sugar Alcohols     According to the Joint Expert Committee of Food Additives of the World Health Organization and the Food and Drug Administration (FDA), sugar alcohols are safe to use for people of all ages (including children) and invidividuals with certain health concerns, such as diabetes and obesity. 


Oral Health and Sugar Alcohols     
Sugar alcohols have been shown to NOT promote dental cavaties and may actually slow or prevent the formation of dental cavaties.  Also, their sweet flavor stimulates the production of saliva, which further reduces plaque formation and increases mineralization of the tooth surface.  In fact, the FDA has allowed the health claim, “does not promote tooth decay” for sugar-free products sweetened with sugar alcohols.

Glycemic Control and Sugar Alcohols     Sugar alcohols may reduce the overall glycemic load, which benefits blood sugar control.  This is especially important for individuals affected by diabetes or those at risk for diabetes.  Sugar alcohols have a low glycemic response and do NOT include a rapid increase in blood sugar or insulin levels after consumption due to their slow and partial digestion in the small intestine.  Changes in blood sugar will vary among different types of sugar alcohols.  For example, the rise in blood sugar will be less with xylitol, sorbitol, and lactitol compared to other types of sugar alcohols. 

Carb Counting and Sugar Alcohols     Many individuals who have had bariatric surgery may have previously had or currently have diabetes and are familiar with the term “carb counting.”  Carb counting is an eating plan method used to help control blood sugar levels.  Some experts in diabetes management advise to subtract half of the grams of sugar alcohol listed on the food label from the total grams of carbohydrates in order to count your exchange or carbohydrate count.  For example, if the total carbohydrate count in a food product is 30 grams and the product contains 16 grams of sugar alcohol, then the total carbohydrate per serving would equal:

 - 16 grams of sugar alcohol / 2 = 8 grams of carbohydrates
-  Total carb count per serving = 30 grams – 8 grams (for sugar alcohols) = 22 grams of carbohydrates

Weight Loss, Weight Maintenance, and Sugar Alcohols     For years, food manufacturers have created foods that include sugar alcohols to improve the variety of great-tasting, low-calorie foods.  Since sugar alcohols are only partially digested, they provide less than the traditional four calories per gram generally assigned to carbohydrates.  Below is the FDA-approved caloric values of various sugar alcohols and sugar:

- Sugar (Sucrose) – 4 calories per gram

- Polysaccharide polyols – 3 calories per gram

- Sorbitol – 2.6 calories per gram

- Xylitol – 2.4 calories per gram

- Maltitol – 2.1 calories per gram

- Isomalt – 2 calories per gram

- Lactitol – 2 calories per gram

- Mannitol – 1.6 calories per gram

- Erythritol – 0.2 calories per gram

Sugar alcohols may be beneficial with helping individuals maintain an overall lower caloric intake.  However, like anything, they are not the only solution to weight loss.  It takes more than only incorporating sugar alcohols into your eating plan to lose weight, such as physical activity and fitness, along with a healthy eating plan.

Like anything, read the Nutrition Facts panel of food products containing this type of sweetener, as some may still contain a significant amount of carbohydrates, fat, and/or calories.

 

Gastrointestinal Health and Sugar Alcohols     Since sugar alcohols are digested differently than sugar, it is possible that there might be side effects associated with sugar alcohols.  Please keep in mind, this information is in general and every individual reacts differently to sugar alcohols, regardless of bariatric surgery or not. 

As previously mentioned, sugar alcohols are not completely absorbed.  The absorbed portion is either metabolized or excreted via urine.  A large portion of the unabsorbed part is metabolized to short-chain fatty acids and gases by bacteria in the large intestine.  There are cells lining the gastrointestinal (GI) tract that use these short-chain fatty acids for energy.  These acids contribute to the formation of an acidic environment.  This promotes the growth of beneficial bacteria, such as Bifidobacteria and Lactobacilli.  Therefore, many sugar alcohols are considered prebiotics due to their ability to stimulate the production of probiotics.

The lower digestibility of sugar alcohols is similar to high-fiber foods.  For some individuals, the overconsumption of sugar alcohol-containing foods may cause undesirable GI symptoms similar to the reactions assocaiated with the overconsumption of high-fiber foods.  The degree of the symptoms is related to a person’s sensitivity and the type of foods eaten or type of sugar alcohol.  Symptoms may include a feeling of fullness, gas, or a laxative effect.  These symptoms are generally mild and temporary if they occur at all.  Some individuals may adapt to sugar alcohols after a few days.  Therefore, if you include sugar alcohols as part of your eating plan, it is recommended to gradually increase the amount to avoid any unnescessary side effects.

Generally speaking, when sugar alcohols are consumed in an amount less than 10 grams per day, they are less likely to cause GI disturbances (i.e., gas, bloating, diarrhea, cramping, etc.).  Sorbitol and xylitol appear to be two of the more tolerable forms of sugar alcohols.  However, remember every individual responds differently to sugar alcohols and the various types and amount of sugar alcohols.

 

In summary, we hope this helps to explain why sugar alcohols are used in the food and beverage industry and why you may want to consider using them as an alternative to sugar.  There are possible benefits and risks related to sugar alcohol consumption and ultimately you have to decide what is right for you.  Read the facts, talk to your physician, and make the best decision you can for yourself regarding your individual, healthy eating plan.

 

 

References:

  1. American Diabetes Association.  Sugar Alcohols.  Available online at:  http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/sugar-alcohols.html.  Accessed July 5, 2016.
  2. University of California at San Francisco.  Diabetes Education Online: Counting Sugar Alcohols.  Available online at: http://dtc.ucsf.edu/living-with-diabetes/diet-and-nutrition/understanding-carbohydrates/counting-carbohydrates/learning-to-read-labels/counting-sugar-alcohols/.  Accessed July 5, 2016.
  3. International Food Information Council Foundation.  Sugar Alcohols Fact Sheet.  Available online at:  http://www.foodinsight.org/Sugar_Alcohols_Fact_Sheet.  Accessed July 5, 2016.
  4. Fitch C, Keim KS.  Academy of Nutrition and Dietetics.  Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners.  J Acad Nutr Diet.  2012;112(5):739-58.